Provider Demographics
NPI:1023772803
Name:RUDNIK, JESSICA DAWN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:RUDNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-7039
Mailing Address - Country:US
Mailing Address - Phone:814-443-0544
Mailing Address - Fax:814-445-7125
Practice Address - Street 1:1606 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7039
Practice Address - Country:US
Practice Address - Phone:814-443-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist